geriatrics in Sweden

Geriatric medicine in Sweden

Number of trainees: approximately 100 at present

Number of specialists: around 450 persons with specialist certificates in geriatric medicine in Sweden working with geriatrics and around 150 in primary care or as internists. At the same time there were 100 physicians undergoing training in geriatric medicine and thus every year there will be 30 – 40 new specialists, but at the same time an equivalent number or even more will retire (at age 65) so the number is decreasing.

Training

Undergraduate training:
The medical faculties have a degree of freedom to choose the curriculum for the medical students. Undergraduate training in geriatric medicine ranges from one to three weeks and is generally given between the seventh to tenth terms of a total of 11 terms. The education is a combination of lectures, patient demonstrations and clinical attendance.
Geriatric medicine has been a recognized specialty since 1969 in Sweden. In December 2005 it was decided that Geriatric Medicine could remain as a specialty in its own right and not, as had been suggested at that time, to become a subspecialty of internal medicine.

Postgraduate training

The curriculum is in concordance with the UEMS – Geriatric Medicine Section training program.

After 21 months of truncal internal training most trainees continue specialist education in geriatric medicine for at least five more years. Training as a geriatrician was standardised across the country in the last years and the goals defined by the Swedish Organisation of Geriatric Medicine together with the National Board of Health and Welfare. Therefore, completion of training involves several years of clinical experience (1,5 to 2 years in Internal Medicine, 6 months in Psychiatry, 2-2,5 years in Geriatric care) plus fulfilment of predefined and structured goals. There are several areas of knowledge where training is compulsory: Palliative care, Dementia, Acute geriatrics, nursing home and ambulatory geriatric care and Geriatric rehabilitation. Once a tutor determines a trainee has acquired sufficient knowledge and skills, an expert in geriatrics from the National Board of Health and Welfare certifies his/her approval becoming then a certified specialist.

Research in Geriatric Medicine

There are six chairs in geriatric medicine (Stockholm, Gothenburg, Malmö, Linkoping, Uppsala, and Umea). Geriatric research in Sweden takes into account relations between medical, psychological and social factors which influence morbidity, and disease prevention.In Malmo and Gothenburg the research is mainly epidemiological in geriatric medicine and gerontology, in Umea the research is clinical and patient-centered (i.e. falls, fracture, sleep apnea, delirium and RAI) and in Stockholm, Uppsala and Linkoping research mainly concentrates on AD.

Organisation of Geriatrics in Sweden

Geriatric medicine in Sweden is mostly a hospital specialty. In the 70 hospitals in Sweden (pop. 9 130.000) there were around 2000 beds were in geriatric medical units out of a total of 22.000 hospital beds at the end of 2010.

There are around 40 independent geriatric medicine clinics, as well as divisions of geriatric medicine in internal medicine clinics in Sweden. Many of these have acute care wards for an initial investigation of older people usually with further planning of care, and also wards for the rehabilitation of stroke and osteoporosis-related fractures and palliative care. Geriatric medicine services are well established in the six university hospitals compared to the rest of the country. In smaller hospitals, there might be only a unit or a ward of geriatric service organized as part of an internal medicine clinic.

Current studies of health care show a growing demand for geriatricians and yet there is a shortage in relation to available positions.

Many geriatric medical clinics have an out-patient unit which is most often specialized for dementia (memory clinics). Patients can be referred from primary care.

Long term care in nursing homes and homes for the older people is mainly the responsibility of primary care and the family physicians but in some cases geriatricians from geriatric medical clinics are in many instances delivering medical and geriatric care to nursing homes.

Only in the capital of Sweden, Stockholm, are there private geriatric medicine clinics, but almost all medical care and especially geriatric medical care in the country is financed publicly.

Journal
SGF journal is Geriatrik with six issues per year. Important information and geriatric medicine research of national interest can also be published in Journal of The Swedish Medical Association.

Scientific meetings and educational activities

From the early seventies an annual scientific meeting takes place (“Riksstämman”). A “Geriatriskt Forum” has been held since 2005 and offers a clinical programme directed to the whole geriatric team. Since 2008 the “Geriatric Research Forum” brings together researchers from all chairs in Sweden allowing for sharing of the latest findings. From 2008 all heads of the Geriatric Departments across Sweden meet once a year and discuss subjects such as training in geriatrics or regulations influencing Geriatric clinics.

Website: www.slf.se/sgf

contacts in Sweden

Dr.

Greger Slättman

greger.slattman@brommageriatriken.se
Professor

Peter Nordström

peter.nordstrom@germed.umu.se